Title: Claims Resolution Specialist Job Description: Location: - Dallas, TX - Fort Worth, TX Remote Full time Calmont Operations Building Department: CBO/PT Financial Services Shift: First Shift (United States of America) Standard Weekly Hours: 40 Summary: The Claims Resolutions Specialist/Account Specialist II is primarily responsible for all insurance follow-up responsibilities for the Cook Children's Physician Network. Primary duties include follow-up, analysis, and resolution of outstanding insurance claims, and initiation of the appeals process on behalf of CCPN providers. Will perform duties such as reimbursement analysis; providing updates to the Manager, Insurance Follow-Up & Denials Management with timely financial and volume data related to claims adjudication and payment trend analyses; performs all required patient account adjustments; provides feedback to practice managers regarding the effectiveness of diagnostic and procedural coding; monitors active accounts receivable for identification of potential problems; serves as a liaison between assigned practice(s) and billing office; communicates effectively with patients, practice managers, physicians and others regarding collection of outstanding claims; maintains proper documentation and edits of work performed; and at all times maintains a professional demeanor to assure that patients are treated in an appropriate and compassionate manner. Note: This is a remote position but will require 1-2 weeks of training in Fort Worth as well as some on site work as needed (candidates must live in DFW area). Required Education/Experience: - High School or equivalent required. - At least 3 years' experience in a physician billing environment (or) at least two (2) years working as an Account Specialist I with Cook Children's with a satisfactory performance record. - Intermediate knowledge of coding and medical terminology. - Strong understanding of diversified health insurance plans a plus. - Experience with managed care contracts, denials and payor methodology. - Extensive knowledge of healthcare third-party reimbursement, variance and denial records. - Effective oral and written communication skills. - Prior experience with Epic Resolute Professional Billing preferred. About Cook Children’s: Our not-for-profit organization is comprised of a flagship medical center in Fort Worth, Texas, a new medical center in Prosper, Texas, a physician network, home health company, surgery centers, health plan, health services, and health foundation. With more than 60 primary, specialty and urgent care locations throughout Texas, families can access our top-ranked specialty programs and network of services to meet the unique needs of their child. Cook Children's is honored to continually receive recognition for our outstanding efforts and outcomes in pediatric health care. At Cook Children's, we're more than a health care system––we're your friends, neighbors and even family members. And we're parents too, so we can see the world through your eyes. We see what you're going through––and how we can help you and your child get the best care and support possible. Cook Children’s is an equal opportunity employer. As such, Cook Children’s offers equal employment opportunities without regard to race, color, religion, sex, age, national origin, physical or mental disability, pregnancy, protected veteran status, genetic information, or any other protected class in accordance with applicable federal laws. These opportunities include terms, conditions and privileges of employment, including but not limited to hiring, job placement, training, compensation, discipline, advancement and termination.

• Supports the claim payment process • Completes regulatory requirements for pharmacy and member payments • Performs complex in-depth analysis and works cross-functionally on projects • Provides guidance to Accounting, Finance, IT and Claims operation functions

• Analyzes and processes complex claims • Works with high exposure claims involving litigation • Ensures ongoing claims within service expectations, industry best practices and specific client service requirements • Identifies and pursues potential third-party subrogation recoveries associated with highest exposure/complexity claims • Reviews high exposure, complex multi-jurisdictional claims to establish potential for third party subrogation recovery • Provides subrogation guidance and direction to both internal and external stakeholders • Develops and pursues third party subrogation • Sends appropriate subrogation lien notifications to appropriate parties • Provides direction to assigned subrogation counsel • Approves and makes timely claim payments relative to subrogation • Manages claim recoveries • Prepares status reports for clients as required • Provides additional layer subrogation expertise to peers • Manages the litigation process • Develops training material and leads department training opportunities

Property & Casualty Claims Analyst - Remote - California Are you a dedicated Claims Analyst ready to unlock a significant growth opportunity with a leading insurance agency? Join a team committed to growth and innovation, where you will be instrumental in developing cutting-edge strategies to minimize risk and optimize the entire claims process. This is your chance to thrive in a collaborative, supportive environment and make a real impact by delivering exceptional client support. What’s in it for you? - Highly competitive annual salary of $90,000 - $110,000 - Comprehensive benefits package, including medical, dental, vision, and a 401(k) plan - Generous paid time off, paid holidays, and a flexible schedule What we need from you: - Minimum of 5 years of dedicated experience in the Property & Casualty Claims sector - Exceptional analytical and quantitative skills with a track record of transforming claims data into actionable insights and strategic recommendations - Extensive knowledge across all commercial P&C insurance lines - Microsoft Office and other critical claims management and database systems The Position: - Manage the full claims lifecycle, monitoring status, and communicating progress to service teams and clients - Serve as a primary contact between clients, insurance carriers, internal teams, and external vendors - Analyze complex claims and coverage issues and implement strategies for resolution with producers and service teams - Review claim documentation and policy terms to ensure accuracy - Investigate and resolve discrepancies to address issues, including identifying potential fraud - Create reports on claim status and emerging trends Apply now! Why Insurance Relief™? As a businessperson in the insurance industry, it is an advantage to partner with a staffing expert and ally who understands your unique skills and needs. With vast experience in the insurance arena, Insurance Relief™ works with brokers, carriers and third-party administrators to locate and place the best people for positions ranging from entry-level to senior management. Compensation / Pay Rate (Up to): $90,000.00 - $110,000.00 Per Year